Impact of Guideline-Directed Management Strategies for Low-Density Lipoprotein Cholesterol Control in Patients Who Underwent Percutaneous Coronary Intervention

Abstract

Background/ObjectiveThere are little direct comparative evidences of strategies between more than 50% and absolute target goal of LDL-C level less than 55mg/dL for the patients underwent percutaneous coronary intervention (PCI). The purpose of this study is to investigate the clinical impact of different strategies between two in patients underwent PCI. MethodsA total of 3,104 patients with prior PCI were retrospectively enrolled from 2014 to 2020 at Yeungnam University Medical Center. The study population was stratified into two groups based on whether LDL-C level were less than 55 mg/dL at one-year mark or not. Furthermore, the 50% reduction rate of LDL-C was also categorized based on whether it had decreased by 50% or more from the initial LDL-C level at the one-year mark. The primary endpoint was 3-year major adverse cardiovascular events (MACE) which was defined as a composite of cardiovascular death, nonfatal myocardial infarction, target-lesion revascularization, hospitalization for heart failure, or non-fatal stroke. ResultsThere was no significant difference between the LDL < 55 mg/dL group and the LDL ≥ 55 mg/dL group in the risk of MACE (hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.81–1.38; P = 0.690) after propensity score matching. However, the group that achieved ≥ 50% reduction of LDL-C from baseline LDL-C level showed a significant reduction in the occurrence of MACE in the subgroup of LDL-C level ≥ 55 mg/dL (HR, 0.41; 95% CI, 0.19-0.89; P= 0.025), compared to the group with < 50% reduction of LDL-C. Among all patients, the achievement rate of target LDL-C < 55 mg/dL and more than 50% reduction from baseline was 17.2%. ConclusionGuideline directed management strategy of more than 50% reduction of LDL-C from the baseline will be needed to reduce the incidence of MACE in PCI treated patients with LDL-C ≥ 55 mg/dL and additional efforts to increase target-goal achievement rate of LDL-C are warranted.